Common Reasons Why Health Insurance Claims Get Rejected

Common Reasons Why Health Insurance Companies Reject Your Claims

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Health insurance policy is the most important investment we make. It helps us protect our family in times of crisis. Further, owning a health insurance policy means your medical expenses are covered. But sometimes, your health insurance claim can be rejected. When a claim gets rejected, your cash flow is affected, leading to stress.

However, stress can be avoided by understanding how to avoid claim rejections. Let’s see different reasons for claim rejection and how to avoid it.

Common Reasons Why Health Insurance Claims Get Rejected

Ten common reasons for health insurance companies to reject policy claims are as follows:  

Providing with Wrong Information

The first reason why health insurance policies get rejected is for wrong information. Make sure you provide correct and genuine information at the time of the proposal. The insurer’s names, age, income, and address must be accurate. Apart from this, the income and lifestyle details of the insured must be correct. The same information such as name and age must be provided at the claim time. Any inconsistency with the information provided at the time of claim can get the policy rejected. 

Wrong Information - Health Insurance Claim

So, it is necessary that the health insurance claim form is filled with correct details. 

Hiding Important Details

One other reason why health insurance claims get rejected is for hiding details. It is important to have proper genuine details in your policy. Disclose any pre-existing illness or issues when applying for an insurance policy. It is because insurance coverage is provided based on the information given. If you hide any pre-existing illness at the time of the proposal, your claim will get rejected. Hence, avoid hiding important details while buying health insurance.

Validity of The Policy

Validity of The Policy - Health Insurance Claim

Every health insurance policy will be valid only for a certain period. Usually, a health insurance policy is valid for one year. At the end of one year, you have to renew the policy. Further, if you fail to renew the health insurance policy, it will lapse. Therefore you cannot make any insurance claim on a lapsed policy. So, check the policy’s validity before filling out a health insurance claim form.

Not Following Proper Insurance Claim Procedure

At the health insurance claim process, you need to follow certain steps. These steps are the procedure set by the company. It includes informing the insurer of the emergency and getting treatment at a recognized hospital. Apart from this, filling out the claim form properly and attaching treatment documents is necessary. Hospital bills with the name of the patients and reports are a must. If a policyholder doesn’t follow this procedure, a health insurance claim can get rejected.

Therefore, read the document and understand how to claim medical insurance in India. Make sure you follow all the steps correctly and avoid getting rejected.


Exclusions - Health Insurance Claim

There is no doubt that a health insurance policy provides financial assistance. But these policies are subjected to terms and conditions. Further, conditions laid down in the policy document are called exclusions. So, read these exclusions mentioned in the policy carefully. Further, make sure to clarify all your questions and understand the conditions. It is because you cannot make any claims against the exclusion mentioned in the policy. In case you make such claims it will get rejected.

Making a Claim After a Deadline

A health insurance company decides a timeline within which the claim has to be submitted. The policy document mentions the time duration they need to be informed. Failing to inform the insurance company within the time limit can get your policy rejected. Therefore, make sure you inform the insurer even in time of emergency. In this way, you can avoid health insurance claim process rejection.

The Procedure Not Being Covered by The Policy

Just because you have a health insurance policy doesn’t mean it covers all medical expenses. At the time of the policy proposal, the executive will inform you of what gets covered. Make sure the health policy covers the procedure you want to get done. If the policy does not cover the procedure or medical condition, you cannot make a claim. Even if you make a claim, the company will reject it.

Not Fulfilling the Waiting Period

Not Fulfilling the Waiting Period - Health Insurance Claim

Health insurance policies include a waiting period. It is a time duration that you need to wait for your policy to kick in. Further, the company decides the waiting period for an insurance policy. It will also be in the policy with the conditions. Make sure you fulfill the condition and waiting period before making a claim. Any health insurance claim status for a condition requiring a waiting period will be rejected.  

Making a Claim More than The Sum Insured

Sum insured is the most important term in a health insurance policy. It means the amount available to the insured person in a year. Further, a policyholder can only claim that amount in a year. A policyholder cannot make any claims for more than the sum insured. In case you make such claims, the company will reject them. 

Incomplete Online Submissions

Incomplete Online Submissions - Health Insurance Claim

Submitting a health insurance claim online is easy. But make sure you follow all the steps involved in the claim process. First, learn how to claim medical insurance online before proceeding. Incomplete submissions or incomplete procedures will get your policy rejected. 


There is no doubt that health insurance policies protect our families. It covers the medical expenses of our loved ones at the time of crisis. But we must understand how the policy works. Understanding the insurance policy will help you avoid getting your claim rejected.

Here in the article, we have listed ten common reasons for rejections. We have also provided information on how to avoid it. Make sure you get your health insurance claim by doing three simple things. First, provide full disclosure; next, follow the conditions and renew the policy every year.


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